Contents
What is a sprain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
What causes an S/C joint injury? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
YOUR GUIDE TO
STERNOCLAVICULAR
(S/C) JOINT
SPRAIN
An IPRS Guide to provide you
with exercises and advice to
ease your condition
What treatment can I receive? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
What exercises should I do? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Phase 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Phase 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Introduction
Please take note of the following
before starting any of the exercises
in this guide:
IPRS are committed to help you
recover in the shortest and safest
possible time.
The information contained in this
guide is intended to assist in
managing your recovery.
This guide is based on the latest
medical research in the field and
contains the best advice available to
the best of our knowledge.
This guide is complimentary to
other medical services and is not
intended as a substitute for a health
care provider’s consultation. Never
disregard medical advice or delay in
seeking advice because of something
you have read in this guide.
Many people have found quick and
lasting relief from their injury by
acting upon the information provided,
but everyone decides for themselves
what to do with this information.
Should you doubt a particular exercise
in your situation, please consult your
health professional.
When consulting your health
professional, it is wise to take this
guide with you to show them.
If you have any uncertainties or
queries regarding the information,
please do not hesitate to contact us on
our free phone number
0800 072 1227 or email us at
info@iprs.uk.com
2
What is a sprain?
A sprain is an injury to a ligament.
Ligaments are strong tissues around
joints which attach bones together
and therefore give support to joints. A
ligament can be stretched during a
sudden pull, which may partly tear
some of the fibres in the ligament.
Occasionally, a ligament may fully
tear (rupture). A damaged ligament
causes inflammation, swelling, and
bleeding (bruising) around the
affected joint, resulting in movement
of the joint being painful and
restricted. The aims of treatment for a
sprain are to keep inflammation,
swelling, and pain to a minimum, and
to be able to use the joint normally
again as quickly as possible.
What is an S/C joint injury?
The SC joint is one of the least
dislocated joints in the body, because
of the strong ligament structure that
surrounds the joint, which is very
effective at preventing dislocations
from occurring. If they do occur, they
are mostly caused by indirect force to
the SC joint, which usually involves
something hitting the shoulder very
hard. The shoulder is pushed in and
rolled either forward or backwards,
affecting the SC joint.
The SC joint connects your clavicle
(collarbone) to your sternum (breast
bone), which is the large bone down
the middle of your chest. This
attachment is the only bony joint
linking the bones of the arm and
shoulder to the main part of the
skeleton.
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When the SC joint is dislocated, it is
usually an anterior dislocation. This
means that the clavicle is pushed
forward, in front of the sternum.
Dislocating in the opposite direction is
less common because the ligaments
on the back side of the joint are so
strong.
Medical Illustration Copyright © 2008 Nucleus Medical Art, All rights reserved.
www.nucleusinc.com
Posterior dislocations although rare
can happen and are caused by direct
force against the front of the clavicle
which can push the end of the clavicle
behind the sternum, into the area
between the lungs. Posterior
dislocations can be very dangerous,
because the area behind the sternum
contains vital organs and tissues. The
heart and its large vessels, the
trachea, the oesophagus, and lymph
nodes, can all be seriously damaged in
a posterior dislocation of the SC joint.
This can cause life-threatening
injuries to the heart and lungs, and
therefore immediate medical care is
required to get the SC joint back into
position after a posterior dislocation.
A Grade II sprain: a complete tear of
the Sternoclavicular ligament, but at
most only a partial tear of the
costoclavicular ligament, result in a
partial dislocation (subluxation) of the
clavicle from its attachment to the
sternum in either a forwards
(anterior) or backwards (posterior)
direction.
A Grade III sprain: there is a
complete tear of the sternoclavicular
and costoclavicular ligaments which
allows the clavicle to completely
dislocate either forwards or
backwards from its attachment to the
sternum.
SC joint injuries can be graded into
3 types.
A Grade I sprain: an incomplete tear
or stretching of the sternoclavicular
(between the collarbone and
breastbone) and costoclavicular
(between the collarbone and ribs)
ligaments, while the SC joint remains
tightly connected. Discomfort is mild,
and no instability is present. This is
the most common type of SC joint
injury.
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What Causes a SC joint injury?
Motor vehicle accidents are the
most common mechanism producing
sternoclavicular dislocation.
Athletic Injury
Falls (e.g. a person falling on an
outstretched arm)
Congenital, degenerative and
inflammatory processes can also
result in dislocations of the SC joint
Ligament Laxity. If ligaments
around the joint are loose. This is
more common in young girls and can
result in anterior dislocations of the
SC joint even when there is no
associated trauma
What treatment can I receive?
Treatment for an SC joint sprain differs
slightly depending on the grade of
injury that has been sustained. For a
grade I sprain treatment is focused on
reducing pain and inflammation,
especially in the first 48 hours after
the injury, and therefore involves rest,
ice, anti inflammatory medication and
a rehabilitation programme. Grade II
and III sprains need to be immobilized
for a lot longer and may require
surgical intervention, therefore it is
important to consult with your doctor
or allied health professional before
engaging in any treatment
programme.
NON SURGICAL TREATMENT
Rest: It is important to rest the
injured ligaments which can be done
either with a sling or the appropriate
strapping of the joint. This is
important to allow the ligaments the
appropriate time to heal. The length
of time the joint should be rested in a
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sling will again very much depend on
the grade of the injury. For a grade I
injury this is usually no longer than a
week or two, whereas for a grade II/III
injury this may be as long as six
weeks.
Ice: This should be applied as soon
as possible after injury for 10-20
minutes. Less than 10 minutes has
little effect. More than 30 minutes
may damage the skin. Make an ice
pack by wrapping ice cubes in a plastic
bag or towel. (Do not put ice directly
next to skin as it may cause an 'iceburn'.) A bag of frozen peas is also a
good alternative. Gently press the ice
pack onto the injured part. The cold
from the ice is thought to reduce
blood flow to the damaged ligament,
which should help to limit pain and
inflammation. After the first
application, some doctors
recommend reapplying for 10-15
minutes every two hours (during day
time) for the first 48 hours.
Anti-inflammatory medication:
Your doctor may prescribe anti
inflammatory medication to try and
reduce the inflammation and pain
after the injury. There are a few antiinflammatory medications that you
can get over the counter, but it is
important that you are aware of any
side affects before taking them
without prescription. These should
always be taken as a course rather
than a one off treatment
Doctors have
different ways of treating anterior
dislocations. Some feel that surgery is
needed when the dislocation is severe,
but most will either let it heal where it
is or perform a closed reduction (put it
back in place, with out performing an
operation). A posterior dislocation is a
little more serious because of the
other organs that may be damaged.
Therefore if a posterior dislocation is
suspected, a full examination will be
required with x-rays, MRI etc being
taken. A doctor will almost always
perform a closed reduction on a
posterior dislocation. After a closed
reduction, the SC joint will be
immobilized with a sling which will
need to be worn for at least 6 weeks.
Closed Reduction:
Physiotherapy: A physiotherapist
may advise on exercises and give
heat/ice, ultrasound, or other
treatments that will aim to decrease
inflammation, decrease pain, and help
you to regain full function. Ruptured
(torn) ligaments and other severe
sprains sometimes require surgery.
SURGICAL TREATMENT
If non surgical measures fail to relieve
your pain, surgery may be considered
by your doctor. Surgery is mostly only
considered if closed reduction has
been unsuccessful (especially if it is a
posterior dislocation). It may also be
considered if symptoms of
osteoarthritis in the joint do not
respond to basic conservative
treatment
PRECAUTIONS WHEN USING ICE
THERAPY.
Ice treatment must be used
carefully otherwise it may cause a
skin burn.
Never put an ice pack directly
onto the skin, always use a damp
towel or cloth to prevent an ice burn.
Only apply an ice pack to areas of
skin with normal sensation i.e. you
must be able to feel hot and cold.
Never put an ice pack over an
open wound or graze.
Do not apply an ice pack to an
area with poor circulation.
Never leave an ice pack on the
skin longer than the time stated in
this advice sheet.
Adults should always supervise
young children when using ice
packs. Application may be reduced
and extra care should be taken when
checking the skin.
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Exercises phase 1
Remember to check the skin
underneath every 5 minutes for:
Whiteness of the skin
Blueness of the skin
Blotchy and painful skin
Excessive numbness
STRETCHES
Perform each exercise 2-3 times,
holding the stretch for 30 seconds.
POSTERIOR CUFF
Take one arm across your chest,
taking care to keep your shoulders
level. Use the other hand to pull
your arm across your body. You may
find this too painful to do initially. Be
guided by your pain and if it makes it
worse then don't do it!
If you get any of these symptoms
remove the ice pack immediately.
What exercises should I do?
Rehabilitative exercises should be
started when the inflammation has
been controlled and pain levels have
reduced. These exercises should
concentrate on increasing overall
strength and flexibility of the shoulder
and arm muscles. It is important that
with all the exercises you work in a
pain free range of motion and
progress from phase 1only when you
are able to complete the exercises in
this phase pain free and with good
control.
Exercises
Keep all exercises in your pain free
Do all exercises slowly and breathe
limits. Trying to work in painful
ranges will only prolong your
recovery.
normally.
If you experience pain during any of
the exercises, decrease the intensity
of the exercises by:
decreasing the number of sets
decreasing the number of
repetitions
decreasing the range of
movement
decreasing the resistance
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Progress gradually according to
your own level of comfort.
Following exercise, stiffness or
fatigue may result but should not last
longer than 24 hrs. The symptoms of
your injury should not be aggravated.
There should not be any pain when
performing a stretch it should be a
comfortable pull.
ANTERIOR CUFF
Grasp your hands together behind
your back, keeping your arms
straight as you raise them. Be
careful not to drop your head
forward.
MOBILITY
Perform each exercise 10 times aim
to repeat this 4-5 times a day.
These exercises should not make
your pain worse. They should be
undertaken within a pain-free range.
FORWARDS/BACKWARDS
PENDULUM
Gently move arm forwards and
backwards by rocking body weight
forwards and backwards. Let arm
swing freely.
Exercise images licensed from Visual Health Information
8
Exercises phase 1 (continued)
CLOCK / ANTI-CLOCKWISE
PENDULUM
Let arm move in a circle clockwise,
then anti-clockwise by rocking body
weight in a circular pattern.
SAWS
Supporting body weight with hand
on table, reach out in front of you.
Pull arm back pinching shoulder
blades together.
SIDE TO SIDE PENDULUM
Supporting body weight with other
hand, gently move arm from side to
side by rocking body weight from
side to side. Let arm swing freely.
STRENGTHENING
You should be aiming to hold these
contractions for 10 seconds. If you can
only manage 5 seconds to begin with
that's fine, aim to build it up to 10
slowly.
Repeat each exercise 10 times, again
aiming to do this 4-5 times a day.
STATIC FLEXION
Place a pillow between your hand
and the wall. Have your elbow bent
to 90° and in at your side. Using a
wall to provide resistance, press fist
into wall as shown, using light /
moderate resistance
STATIC EXTENSION
Place a pillow between your elbow
and the wall. Have your elbow bent
to 90° and arm in at your side. Make
sure that your shoulders are in a
neutral position. Press back of arm
into wall using light / moderate
resistance.
INTERNAL ROTATION
Stand with your arm close to your
side, with a pillow placed between
your side and your elbow, and your
elbow at a right angle. Push the palm
of your hand against the other hand
inwards. Hold for 10 sec. Repeat 10
times on each arm.
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10
Exercises phase 1 (continued)
EXTERNAL ROTATION
Stand with your arm close to your
side, with a towel placed between
your side and your elbow, and your
elbow at a right angle. Push the back
of your hand against a wall. Hold for
10 sec. Repeat 10 times on each arm.
PRONE FLIES 1
Lying on your stomach with your
arms next to your side and forehead
rested on a rolled up towel. Move
your shoulder blades down your
back, and bring the points in towards
each other with out moving your
arms. Keeping your shoulder blades
stable, now raise your arms slightly
off the ground and hold for 10
seconds. Repeat 10 times
Now try and progress the above
exercise by holding small weights in
your hands
Exercises phase 2
Phase 2 exercises can be started
when you are able to do all the
Mobility and Strengthening exercises
in Phase 1 with no adverse effects.
Continue with the stretches of phase 1
MOBILITY
Perform each exercise 10 times aim
to repeat this 4-5 times a day.
These exercises should not make
your pain worse. They should be
undertaken within a pain-free range.
FLEXION WITH STICK
Bring stick directly overhead,
leading with uninvolved side until
you feel a stretch. Only work in a
pain free range of movement.
ABDUCTION WITH STICK
Holding stick with involved side palm
up, push stick directly out from your
side with uninvolved side (palm
down) until you feel a stretch.
INT. / EXT. ROTATION WITH
STICK
Hold stick with involved side palm
up, push with uninvolved side (palm
down) out from body while keeping
elbow at side until you feel a stretch.
Then pull back across body leading
with uninvolved side. Be sure to
keep elbows bent.
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12
Exercises phase 2 (continued)
STRENGTHENING
You should be aiming to perform
Repeat each exercise 10 times, again
these exercises slowly, concentrating
on controlling the movement. Try
counting to 5 as you perform the
movement, it should take you this long
to do one repetition of one exercise!
aiming to do this 4-5 times a day.
RESISTED FLEXION
Using elastic tubing / band start with
arm at side and pull arm outward
and upward. Move shoulder through
pain free range of motion.
RESISTED ABDUCTION
Using elastic tubing / band start with
arm across body and pull away from
side. Move through pain free range
of motion.
RESISTED INTERNAL ROTATION
Using elastic tubing / band and
keeping elbow in at side, rotate arm
inward across body. Be sure to keep
forearm parallel to floor. The
movement should be slow and
controlled
RESISTED EXTENSION
Using elastic tubing / band pull arm
back. Be sure to keep elbow straight.
RESISTED ABDUCTION
Using elastic tubing / band pull arm
in toward buttock. Do not twist or
rotate trunk.
RESISTED EXTERNAL ROTATION
Using elastic tubing / band and
keeping elbow in at side, rotate arm
outward away from body. Be sure to
keep forearm parallel to floor. The
movement should be slow and
controlled
13
14
Exercises phase 2 (continued)
SCAPULAR STABILIZATION
IN PRONE
Lying on your stomach, with arms
out to the side (i.e. in line with your
shoulders), take your shoulder
blades down your spine, bringing the
points in towards each other. Now
raise both arms off of floor. Keep
elbows straight and control the
shoulder blades being sure not to
shrug. Hold for 10 seconds and
repeat 10 times
Now try and progress the above
exercise by holding small weights in
your hands
RESISTED EXTERNAL
ROTATION AT 90°
Sitting on a chair facing the door,
with your elbow rested on a table.
Your elbow should be about
shoulder height and bent to 90°.
Attach tubing (which you can get
from your physiotherapist) to the
door making sure it is secure. Pull
tubing away from door, keeping
elbow bent at a right angle. Make
sure the movement is slow and
controlled
15
RESISTED INTERNAL
ROTATION AT 90°
Sitting on a chair facing away from
the door, with your elbow rested on a
table. Your elbow should be about
shoulder height and bent to 90°.
Attach tubing (which you can get
from your physiotherapist) to the
door making sure it is secure. Pull
tubing away from door, keeping
elbow bent at a right angle. Make
sure that the movement is slow and
controlled
FUNCTIONAL EXERCISES
It is important to train back to
function and the following exercises
will help you to do this by combining a
number of movements in one.
The tennis exercises can be
substituted with movements that may
be involved in your own sport e.g. a
golf swing, throwing movements etc
Again it is important to work in a pain
free range, and you may only be able
to start these exercises after doing
phase 2 exercises for a week of two.
DIAGONAL FLEXION 1
Using tubing, start with arm out
from side, palm down. Pull arm up,
out and across body, rotating arm as
you move so thumb continues to
point back.
16
Exercises phase 2 (continued)
DIAGONAL FLEXION 2
Using tubing, start with palm facing
behind you. Pull arm out, up and
across body rotating arm as you
move so palm continues to face
behind you.
Contact us
This guide is designed to assist you in the
self-management of your injury/condition.
We are here to assist your recovery in the
shortest but safest possible time. If you
have any uncertainties or queries
regarding the information, please do not
hesitate to contact us on:
Tel: 0870
756 5020 / 07870166861
Phone
017890400999
E-mail: info@iprs.uk.com
www.mdphysiotherapy.co.uk
DIAGONAL EXTENSION 1
Grasp tubing with arm reaching
above shoulder and across body.
Gently pull downward and away from
your body. Return slowly to starting
position.
DIAGONAL EXTENSION 2
Grasp tubing with arm above and
behind you. Bring arm downward
and across body. Return slowly to
starting position.
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